View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Healthy People 2030 Champion Application	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Healthy People 2030 Champion Application	Healthy People 2030 Champion Application	Healthy People 2030 Champion Draft Application March 2022.docx		Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	800	0	800	0	0	0
Annual IC Time Burden (Hours)	320	0	320	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
HP2030 Application Supplement	HP2030 Champions Application 0990-0281 Supporting Statement A_Template 3.31.docx	04/04/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.